AB0513 SCREENING FOR HYDROXYCHLOROQUINE-INDUCED CARDIOMYOPATHY: A PROSPECTIVE OBSERVATION IN PATIENTS WITH CONNECTIVE TISSUE DISEASE WHO HAVE BEEN ON TREATMENT FOR MORE THAN 5 YEARS
Authors: M. Ford, S. Tosounidou
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Antimalarial-induced cardiomyopathy is a rare complication of prolonged use of antimalarial treatment. It can present with a conduction disorder, heart failure, or ventricular hypertrophy [1]. A systematic review has highlighted that early recognition and drug withdrawal are crucial and can potentially lead to recovery of cardiac function in up to 45% of patients. Despite this, there remains a significant risk of irreversible damage and death despite discontinuation (12.9% and 30.8% respectively) [2]. <h3>Objectives</h3> After identifying our first case of Hydroxychloroquine-induced cardiomyopathy in our department [3], we decided to review the prevalence of this complication in a cohort of patients to determine the need for a screening tool to assess the cardiovascular risk in patients prescribed Hydroxychloroquine for longer than 5 years duration. <h3>Methods</h3> We identified a selection of patients with a diagnosis of a Connective Tissue Disease who had been prescribed Hydroxychloroquine for longer than 5 years. We performed cardiac screening including N-terminal-pro-BNP (NT-pro-BNP), Troponin I (TnI), Creatine Kinase (CK) and an Electrocardiogram (ECG). A basic tool was used to determine the need for further investigations (Echocardiogram +/- Cardiac magnetic resonance imaging) to evaluate the presence or absence of Hydroxychloroquine-induced cardiomyopathy. <h3>Results</h3> A total of 124 patients met the specified criteria of which 115 were female (92.7%) and 9 were male (7.3%) with a mean age of 48 years. The underlying diagnoses included Systemic Lupus Erythematosus (n=103, 83.1%), Mixed CTD (n=9, 7.3%), Sjögren's Syndrome (n=6, 4.8%), Undifferentiated CTD (n=5, 4.0%), and Systemic Sclerosis (n=1, 0.8%). A total of 40 patients (32.3%) had been prescribed Hydroxychloroquine for 5-10 years duration compared to 84 patients (67.7%) who had been prescribed for over 10 years duration. Daily Hydroxychloroquine dose varied from 0-200mg (n=15, 12.1%), 200mg (n=55, 44.3%), 200-400mg (n=13, 10.5%), and 400mg (n=41, 33.1%). Abnormal results which warranted further investigation included raised levels of NT-pro-BNP (7.6%), TnI (4.2%), and CK (11.7%), and specific features seen on ECG (19.3%). A total of 31 patients were investigated using Echocardiography and none of these patients exhibited features suggestive of cardiomyopathy. <h3>Conclusion</h3> We did not identify any patients within this cohort with features suggestive of Hydroxychloroquine-induced cardiomyopathy. Despite the condition being rare, the true prevalence is unknown. Clinicians should remain vigilant and consider including a cardiovascular risk assessment in the long-term management of patients taking Hydroxychloroquine especially in high-risk patients such as those with a high cumulative dose of the medication [3]. <h3>References</h3> [1]Tselios, K., Deeb, M., Gladman, D.D., Harvey, P. and Urowitz, M.B., 2018. Antimalarial-induced cardiomyopathy: a systematic review of the literature. Lupus, 27(4), pp.591-599. [2]Chatre, C., Roubille, F., Vernhet, H., Jorgensen, C. and Pers, Y.M., 2018. Cardiac complications attributed to chloroquine and hydroxychloroquine: a systematic review of the literature. Drug safety, 41(10), pp.919-931. [3]Lodge, F.M., Moody, W.E., Tosounidou, S., Chue, C.D., Curtis, E., Neil, D.A. and Bradlow, W., 2021. Hydroxychloroquine-induced cardiomyopathy accelerated after gastric banding. The Lancet, 398(10314), p.1913. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.